Dear Dr Carlyon, Thank you for your report regarding the sad and untimely death of Robert Lloyd on the Isles of Scilly on the July. In response to the regulation 28 report / hereby outline the actions we have undertaken as a practice to help to prevent such a death again: met withl of the Drug and Alcohol Action Team of Cornwall Council, on the 12th January to discuss future services and how we can work together to ensure services improve We will shortly be having a new Addaction worker on the Islands who will visit every 2 weeks. This will be a vast improvement on the previous set-up, where often contact was by telephone or Skype. We will host his sessions here at the surgery to ensure that we improve multi-agency working: He will also be able to feed into our multi-disciplinary team meetings for clients as required: In addition to this, training for our two pharmacists has been undertaken, to try and identify those who are at risk of harm from excess alcohol consumption and we are carrying out an audit of those who are recorded on our General Practice notes as having an alcohol intake of greater than the recommended limits. This will assist us in targeting advice to those who most need it, with the aim of increasing referrals to Addaction. Both Angela and sit on the Community Safety Partnership, so we will ensure that the subject of problem alcohol use is on the agenda. The main focus of the CSP this year is around domestic abuse, so enhanced alcohol services will sit well alongside this as a focus. King 30th_

We all recognise that services have fallen short of what is expected over the last few years, but am confident that this case will prove to reinvigorate the local offer, and will make services safer in the future If you need further information please do not hesitate to contact me_

Dear Dr Carlyon,

Re: Regulation 28 report Mr Robert Lloyd

I am writing in my capacity as commissioner of alcohol and drug treatment services for Cornwall & Isles of Scilly, in response to your letter dated 29th November 2016, issuing a Regulation 28 report regarding the death of Mr Robert Lloyd 30th July 2016. Your report asked me to review the provision of support to dependent drinkers on the Isles of Scilly with a view to preventing future deaths. Before I do so, I would like to say how sad we were to learn of Robert’s death. It had already been recognised that it was far too challenging for individuals to secure sufficient help on the islands with drug and alcohol problems and we were engaged in a review process, with the islands, to ascertain how best we all might meet peoples’ needs within the available resources. CIOS DAAT committed to undertaking a needs assessment with IOS during 2016-17. A member of our team has been working with the Council for the Isles of Scilly, health partners, the police and Addaction to identify ways in which we could all improve provision. Initial work has included interviews with key health and social care personnel, staff working in housing, licensing, school and police. The public survey conducted in conjunction with IOS Healthwatch received more than 30 responses. Feedback and anecdote estimate high prevalence of problematic drinking on IOS with a degree of disruption to the community including anti-social behaviour and visible health burdens (see attached report update October 2016). In addition, a joint improvement plan is in place with Addaction, the commissioned provider of specialist drug and alcohol treatment services for IOS

(also attached), who had also produced a report looking at service delivery to the islands. Both reports support the view that the community needs more support and a more visible therapeutic presence on the islands to encourage more islanders to access advice, information and treatment for alcohol and drug dependency. A new Adults Recovery Co-ordinator has been appointed, with a brief to be more proactive. He has commenced fortnightly visits to the islands. He will also have back/replacement cover for sickness and annual leave, will establish a regular AA meeting on the islands, to replace the need for islanders having to travel to the mainland for this, and provide support for affected others (families and friends). YZUP continue to provide support and advice for families and young people. However, there continue to be very low numbers engaging by comparison to the level of need described and the purpose of a stakeholder meeting is to explore means of more assertively identifying and engaging those who would benefit from earlier help. There is also always the challenge of delivery from the mainland when the weather obstructs. Therefore, a longer term view has been to train a wider range of professionals and residents to be better able to support people with dependency issues on the islands. In summary response:
1. The contract we hold with Addaction requires a minimum of fortnightly island visits in 2017-18. This to deliver interventions which will include face-to face contact with the Recovery Co-ordinator; a drop-in session; IOS specific resources; access to both home detox and community hospital detox; appropriate prescribing for medical problems; access to volunteer supporters; and group therapy. Visits can be supported, but not replaced, by Skype. Cover will be made available for any sickness or annual leave. Some of these services will be made available on the off islands, but this has yet to be worked up.
2. An AA and NA meeting will be delivered on the islands rather than having to transport people to the mainland for this purpose.
3. Where there has been a hospital admission on the mainland, RCHT Alcohol Liaison Team have agreed a joint protocol to contact the designated Addaction Recovery Coordinator for the islands to facilitate a referral for anyone admitted who is not engaged in community treatment, into treatment, once discharged.
4. Multi-agency professionals meetings will identify individuals to assertively engage in treatment and support that engagement

5. The GPs serving the IOS are trained to offer the full spectrum of primary care alcohol and drug treatments.
6. Pharmacy staff are trained to screen patients to identify risks to health through drinking.
7. A full package of training for all personnel serving the islands in screening for alcohol use and awareness will be offered again in April 2017.
8. Further steps will de identified through the review and needs assessment currently underway.
9. An IOS specific Needs Assessment and commissioning intentions for 20117-18 is in progress, due to complete by 31st March 2017
10.We will make a continuing investment in DAAT staff support for the islands, including representation on strategic groups such as the Community Safety Partnership.

We have reviewed Addaction’s copy of their report to you on this matter and I confirm that I support the lessons learnt.

I believe that these steps will address the issues highlighted within your report, but that there is still more work to do to raise awareness and improve services available to islanders, thereby preventing future deaths. We commit to keeping the situation and improvement plan under regular review through quarterly Contract Review meetings with Addaction and with the Isles of Scilly Council and stakeholders.

If you require any further information, please do not hesitate to contact me.